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Volume 14
Issue 9
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Healthcare, Volume 14, Issue 9 (May-1 2026) – 141 articles

Cover Story (view full-size image): This scoping review explores how obstetric nurses navigate evidence-based breastfeeding practices in the context of HIV. Beyond technical guideline implementation, the findings reveal complex ethical, clinical, and contextual challenges influencing counselling and decision-making. Variability in knowledge translation, professional training, and institutional support may affect the consistency of care provided to women living with HIV. The review highlights the critical role of obstetric nurses in bridging scientific evidence, maternal autonomy, and individualized care, while also identifying the need for profession-specific research, reflective education, and stronger evidence-informed practice frameworks. View this paper
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14 pages, 572 KB  
Review
Music Listening in Medicine and Healthcare: A Scoping Review
by Alfredo Raglio, Virginia Cavallari, Joanna Carvelli, Federica Grossi and Marina Rita Manera
Healthcare 2026, 14(9), 1256; https://doi.org/10.3390/healthcare14091256 - 6 May 2026
Viewed by 610
Abstract
Background: Music listening is increasingly applied in medical and healthcare settings as a non-pharmacological intervention to modulate psychophysical outcomes such as anxiety, pain, stress, mood, and physiological parameters. Despite a rapidly expanding evidence base, receptive music-based interventions remain highly heterogeneous with respect [...] Read more.
Background: Music listening is increasingly applied in medical and healthcare settings as a non-pharmacological intervention to modulate psychophysical outcomes such as anxiety, pain, stress, mood, and physiological parameters. Despite a rapidly expanding evidence base, receptive music-based interventions remain highly heterogeneous with respect to theoretical rationale, music design, and methodological rigor. Objective: The primary aim of this review was to critically examine methodological and conceptual limitations of music listening approaches (based on pre-recorded music listening, without the presence of the music therapist during the listening phase) and to map the range of such interventions across clinical domains. Methods: A systematic search of PubMed was independently conducted by two reviewers for randomized controlled trials published between January 2020 and December 2025. Eligible studies investigated psychophysical outcomes of pre-recorded music listening in clinical or medical populations. Studies involving music listening in relational settings, live music, multimodal interventions, or neuromotor rehabilitation were excluded. Results: Of 280 records initially identified, 63 studies met the inclusion criteria. Most studies employed conventional familiar music, frequently self-selected by participants. Fewer than half reported explicit musical parameters, and only five studies documented the involvement of a certified music therapist. Substantial heterogeneity was observed in music listening experiences, potentially confounding outcome interpretation. Conclusions: Although music listening interventions appear feasible and potentially beneficial across diverse clinical contexts, major methodological and conceptual limitations persist. Greater involvement of music therapy professionals, standardized reporting of musical parameters, clearer theoretical rationales linking musical structure to clinical outcomes, and improved control group design are required to enhance reproducibility, interpretability, and clinical translation. Full article
(This article belongs to the Section Clinical Care)
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13 pages, 260 KB  
Article
Changes in Disease Severity and Outcomes Among Electively Admitted Cirrhosis Patients During the COVID-19 Era
by Melania Veronica Ardelean, Dana Roxana Buzas, Alin Viorel Istodor, Paul Ciubotaru, Vlad Ivan, Norina Simona Basa, Daniel Florin Lighezan, Dan Iliescu and Ovidiu Florin Ardelean
Healthcare 2026, 14(9), 1255; https://doi.org/10.3390/healthcare14091255 - 6 May 2026
Viewed by 325
Abstract
Background: Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, had profound primary effects on global health and secondary effects through widespread disruption of healthcare systems, limiting access to elective medical services essential for the management of chronic diseases such as liver [...] Read more.
Background: Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, had profound primary effects on global health and secondary effects through widespread disruption of healthcare systems, limiting access to elective medical services essential for the management of chronic diseases such as liver cirrhosis. Elective hospitalizations play a key role in disease monitoring, prevention of complications, and therapeutic optimization. This study aimed to evaluate the impact of the pandemic on the clinical profile, disease severity, and outcomes of patients electively admitted with liver cirrhosis across three periods: pre-pandemic, pandemic, and post-pandemic. Methods: This retrospective, single-center cohort study included 248 adult patients electively admitted with a primary diagnosis of liver cirrhosis between February 2018 and February 2024. Patients were stratified according to admission period. Data on demographics, clinical presentation, etiology, decompensation markers, severity scores (Child–Pugh, Baveno), procedures, and hospitalization outcomes were analyzed. Results: A total of 248 patients were included, with a significant reduction in elective admissions during the pandemic (23.0% vs. 46.4% pre-pandemic), followed by partial recovery post-pandemic (30.6%) (p = 0.031). A higher proportion of urban patients was observed during the pandemic (70.2%, p = 0.004). Disease severity increased during the pandemic, with a higher prevalence of Child–Pugh C (17.5%) and Baveno stage 6 (10.5%), whereas post-pandemic data showed improvement (Child–Pugh C: 6.57%; no Baveno stage 6; p = 0.004). Ascites (47.4%) and paracentesis (21.1%) peaked post-pandemic (p = 0.012; p = 0.003). Endoscopic activity decreased during the pandemic (22.8%, p = 0.017), while interventional procedures were more frequent (8.8%, p = 0.045). Transfusion requirements (17.5%, p = 0.001) and hospitalization costs (€467.08, p = 0.01) were highest during the pandemic, while no deaths were recorded post-pandemic. In-hospital mortality was observed in 1.7% of patients during the pre-pandemic period and increased to 3.5% during the pandemic period, while no deaths were recorded post-pandemic. Conclusions: The COVID-19 pandemic significantly altered elective cirrhosis care, leading to reduced admissions, increased disease severity, and higher resource utilization. Although partial recovery was observed post-pandemic, persistent evidence of delayed decompensation underscores the importance of maintaining continuity in elective hepatology services. Full article
(This article belongs to the Special Issue Performance of Healthcare Systems During and After the COVID-19 Pandemic)
12 pages, 642 KB  
Article
Association Between Frailty, Locomotive Syndrome, and Subjective Well-Being Among Community-Dwelling 80-Year-Old Adults in Japan: A Pilot Study
by Tamaki Hirose, Yohei Sawaya, Masahiro Ishizaka, Naori Hashimoto and Tomohiko Urano
Healthcare 2026, 14(9), 1254; https://doi.org/10.3390/healthcare14091254 - 6 May 2026
Viewed by 350
Abstract
Objectives: Despite growing interest in locomotive syndrome (LS), its relationship with subjective well-being remains unclear, highlighting a gap in the existing literature. Therefore, as a pilot study providing preliminary insights, this study aimed to clarify the association of subjective well-being (life satisfaction and [...] Read more.
Objectives: Despite growing interest in locomotive syndrome (LS), its relationship with subjective well-being remains unclear, highlighting a gap in the existing literature. Therefore, as a pilot study providing preliminary insights, this study aimed to clarify the association of subjective well-being (life satisfaction and happiness) with LS and frailty, a key concept in geriatric medicine, among community-dwelling individuals. Methods: We conducted a cross-sectional study of 111 older adults aged 80 years living in City A, Tochigi Prefecture, Japan. LS (5-question Geriatric Locomotive Function Scale [GLFS-5]), frailty (Kihon Checklist [KCL]), and subjective well-being (life satisfaction and happiness) were assessed. Group comparisons were performed based on life satisfaction (Satisfied vs. Unsatisfied) and happiness (Happy vs. Unhappy). Binary logistic regression analyses were also conducted, with LS and frailty as dependent variables and subjective well-being (Satisfied–Happy [reference], Satisfied–Unhappy, Unsatisfied–Unhappy) as independent variables. Results: LS was observed in 32 participants (28.8%), and frailty was observed in 25 participants (22.5%). In the group comparisons, the prevalence of LS and frailty was significantly higher in the Unsatisfied and Unhappy groups. In multivariable analyses, the Unsatisfied–Unhappy group was significantly associated with LS (p = 0.002) and frailty (p = 0.031). Conclusions: Among community-dwelling individuals aged 80 years, low life satisfaction and happiness were shown to be associated with LS and frailty. Full article
(This article belongs to the Special Issue Impact of Lifestyle, Health Conditions and Medical and Family Care on the Quality of Life of the 80+)
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17 pages, 3331 KB  
Article
Service Dog Training Interventions for Veterans with Post-Traumatic Stress: Examining Gender-Based Differences in Psychosocial Outcomes
by Shahar Almog, Cheryl A. Krause-Parello, Alejandra Quintero, Deborah Taber and Erika Friedmann
Healthcare 2026, 14(9), 1253; https://doi.org/10.3390/healthcare14091253 - 6 May 2026
Viewed by 438
Abstract
Background: Poor mental health is prevalent among veterans who suffer from post-traumatic stress disorder (PTSD) and other psychiatric conditions. Canine-assisted interventions may improve psychological and social health in veterans. The parent study, a randomized controlled trial, revealed improvements in PTSD following both a [...] Read more.
Background: Poor mental health is prevalent among veterans who suffer from post-traumatic stress disorder (PTSD) and other psychiatric conditions. Canine-assisted interventions may improve psychological and social health in veterans. The parent study, a randomized controlled trial, revealed improvements in PTSD following both a service dog training program and an active control condition consisting of virtual dog training lessons. Thus, in the present post hoc secondary analysis, we analyzed both groups together (pooled arms) to examine gender-based differences in the effects of the altruistic service dog training programs on psychosocial outcomes. Methods: Veterans (N = 59) participated either in hands-on (with a dog and trainer) or virtual (no dog present) dog training programs over eight weeks and completed self-reported psychosocial measures before and after the program. Mixed-effect linear models were used to assess the interaction between time and gender on a series of psychosocial outcomes in the pooled sample. Results: The findings supported greater psychosocial improvements for female participants compared to male participants, including significant improvements in PTSD, perceived stress, and perceived physical health, and feeling greater closeness and lower avoidance in close relationships (ps < 0.05). The results revealed moderate to large effect sizes among female participants, suggesting meaningful clinical effects of the interventions (ds = 0.47–0.70). Conclusions: While the secondary analysis and small sample size limit causal inferences, the exploratory evidence suggests greater improvements in psychosocial health in female veterans after participating in the service dog training programs. Future research should tailor interventions to optimize the therapeutic effects for male and female veterans and identify other individual characteristics involved, such as combat exposure or post-traumatic stress symptom severity. Full article
(This article belongs to the Special Issue Human–Animal Interaction: Animal Behaviour and Whole-Person Health in Animal-Assisted Interventions)
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10 pages, 212 KB  
Article
Exploring the Psychosocial Impact on Families Caring for Children with Cerebral Palsy: A Qualitative Study in Saudi Arabia
by Norah G. Alkhaledi, Regie B. Tumala, Abdualrahman S. Alshehry and Naif H. Alanazi
Healthcare 2026, 14(9), 1252; https://doi.org/10.3390/healthcare14091252 - 6 May 2026
Viewed by 365
Abstract
Background: Parents of children with cerebral palsy (CP) experience several challenges in providing care, which can impact the child’s quality of life. CP is one of the most common neurological conditions that demand a great deal of time and effort from caregivers. Purpose: [...] Read more.
Background: Parents of children with cerebral palsy (CP) experience several challenges in providing care, which can impact the child’s quality of life. CP is one of the most common neurological conditions that demand a great deal of time and effort from caregivers. Purpose: To explore the psychological and social effects experienced by Saudi families while rearing children with CP. Methods: This research utilizes qualitative research methods. The purposive sampling method was used to select 13 caregivers of children with CP from the Children with Disability Association in Riyadh, Saudi Arabia. Personal interviews were conducted with a group of parents, then these interviews were analyzed to derive the experiences of the participants. Results: The findings highlighted the difficulties that these families go through from the moment the diagnosis was made, as well as other care burdens, including costs, isolation, and continuous anxiety and worries about the future of the children. Conclusions: This study identifies the need for organized psychological and social support, which has a significant impact on enhancing adaptability and the lives of the children. Full article
(This article belongs to the Special Issue Psychosocial Aspects of Childhood and Adolescent Health)
17 pages, 561 KB  
Article
Living Alone as a Persistent Risk Factor for Smoking and High-Risk Drinking: A Three-Year Repeated Cross-Sectional Analysis Before and During the COVID-19 Pandemic in the Republic of Korea
by Sarang Jang
Healthcare 2026, 14(9), 1251; https://doi.org/10.3390/healthcare14091251 - 6 May 2026
Viewed by 261
Abstract
Background: Single-person households have grown rapidly in the Republic of Korea and are consistently associated with higher rates of smoking and high-risk drinking. However, it remains unclear whether this vulnerability is structural and chronic or merely situational. This study examined whether the [...] Read more.
Background: Single-person households have grown rapidly in the Republic of Korea and are consistently associated with higher rates of smoking and high-risk drinking. However, it remains unclear whether this vulnerability is structural and chronic or merely situational. This study examined whether the COVID-19 pandemic—a major societal disruption—altered the preexisting behavioral gap between single- and multi-person households. Methods: We used repeated cross-sectional data from the Korea Community Health Survey (KCHS) for 2019 (unweighted n = 229,099), 2020 (unweighted n = 229,269), and 2021 (unweighted n = 229,242), representing weighted populations of approximately 43.0, 43.5, and 43.6 million adults aged ≥19 years, respectively. We applied complex sample logistic regression models including an interaction term between survey year and household type, adjusting for sex, age, income, and education. Results: High-risk drinking significantly declined in both household types across all three time points following the COVID-19 pandemic, whereas smoking showed no significant overall change. Critically, the year x household type interaction was non-significant for high-risk drinking across all years; for smoking, a marginally significant interaction emerged only in 2021 (adjusted odds ratio [AOR] = 1.08, 95% CI: 1.01–1.16), suggesting a slight but limited divergence in the later pandemic period. Single-person households consistently showed higher odds of smoking (AOR = 1.65, 95% CI: 1.56–1.74) and high-risk drinking (AOR = 1.32, 95% CI: 1.25–1.39) across all three time points, relative to multi-person households and referenced to 2019 as the pre-pandemic baseline. Conclusions: The health behavioral vulnerability of single-person households is structural and persistent, underscoring the need for household-structure-sensitive public health strategies to promote sustainable well-being. Full article
(This article belongs to the Special Issue Promoting Preventive Care and Health Promotion in Primary Care)
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13 pages, 628 KB  
Study Protocol
Hybrid Tele-Rehabilitation in the Management of Pediatric Chronic Suppurative Lung Diseases: Study Protocol for a Randomized Controlled Trial
by Aspasia Mavronasou, Panagiotis Dalamarinis, Arietta Spinou, Dafni Moriki, Konstantinos Douros and Eleni A. Kortianou
Healthcare 2026, 14(9), 1250; https://doi.org/10.3390/healthcare14091250 - 6 May 2026
Viewed by 711
Abstract
Background: The pediatric population with chronic suppurative lung diseases (CSLDs) presents with a clinical profile of persistent productive cough and impaired airway clearance, which leads to reduced exercise capacity and physical activity (PA). The main objective of this research is to evaluate the [...] Read more.
Background: The pediatric population with chronic suppurative lung diseases (CSLDs) presents with a clinical profile of persistent productive cough and impaired airway clearance, which leads to reduced exercise capacity and physical activity (PA). The main objective of this research is to evaluate the effect of a 12-week intervention that combines airway clearance techniques (ACTs) and exercise training delivered through synchronous (videoconferencing) and asynchronous implementation at home, supported by an informative, specially designed website and supervised by a physiotherapist on exercise capacity. The secondary objective is to assess adherence to the ACT performance. The hypothesis of the study is that this hybrid tele-rehabilitation program will improve functional and exercise capacity, as well as compliance with ACTs, compared to the usual care. Methods: Thirty-two children with CSLDs (other than cystic fibrosis) will be randomly assigned to either the intervention group (home-based, synchronous, and asynchronous ACTs and exercise training) or the control group (usual care). An assessor blind to group allocation will measure the modified shuttle walk test, 6-minute walking test, Chester step test, respiratory muscle strength, handgrip, pulmonary function, PA, sedentary behavior, and quality of life at baseline, at the end of the intervention (3 months), and 6 months after completion. Discussion: This study introduces a hybrid (synchronous and asynchronous) tele-rehabilitation program, aiming to improve physical capacity and adherence to physiotherapy management for pediatric CSLD populations. Full article
(This article belongs to the Special Issue Remote Interventions in Patients with Chronic Lung and Cardiovascular Diseases)
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24 pages, 310 KB  
Review
Compassionate Extracorporeal Membrane Oxygenation Discontinuation: A Narrative Review and Practical Process Model for Reliable End-of-Life Care
by Kinsley Hubel, Raju Reddy, Akram Khan, Jonathan Pak and Nehan Sher
Healthcare 2026, 14(9), 1249; https://doi.org/10.3390/healthcare14091249 - 6 May 2026
Viewed by 545
Abstract
Background and Objectives: Extracorporeal membrane oxygenation (ECMO) provides temporary respiratory or circulatory support when conventional therapies fail. Some patients do not recover and are not candidates for transplant or durable mechanical support. In these cases, continuing ECMO may no longer align with the [...] Read more.
Background and Objectives: Extracorporeal membrane oxygenation (ECMO) provides temporary respiratory or circulatory support when conventional therapies fail. Some patients do not recover and are not candidates for transplant or durable mechanical support. In these cases, continuing ECMO may no longer align with the patient’s goals. Compassionate ECMO discontinuation (CED) is the planned withdrawal of extracorporeal support with death anticipated. The term “compassionate” refers to the goal of minimizing suffering in the end-of-life process. This review proposes a reliability-oriented framework to standardize CED and reduce preventable distress for patients, families, and clinicians. Materials and Methods: We conducted a targeted narrative review of ethical analyses, consensus guidance, and empirical literature on planned ECMO withdrawal. The results of the narrative review were combined with our existing practical process for CED into this proposed reliability-oriented framework as a guide for clinicians. Recommendations were organized into a four-phase process model that emphasizes operational implementation, anticipatory guidance, and quality improvement. We included modality-specific considerations for veno-arterial (VA), veno-venous (VV) ECMO, and extracorporeal cardiopulmonary resuscitation (ECPR). Results: The framework includes four phases. Phase I, Anticipation and Alignment, emphasizes structured shared decision-making, early expectation setting, time-limited trials, palliative care integration, and predefined pathways for managing disagreement. Phase II, Preparation, includes interdisciplinary role assignment, a pre-withdrawal time out, family coaching on expected physiological changes, and preemptive comfort medications that account for ECMO-altered pharmacokinetics. Phase III, Implementation, prioritizes comfort first, pacing with explicit pause points, environmental controls to reduce alarms and visual distress, and modality-tailored sequencing. Phase VI, Aftercare and Learning Capture, includes bereavement support, standardized documentation, structured team debriefing, and recommended process measures to guide improvement. Conclusions: Viewing CED as a low-frequency, high-stakes clinical process supported by scripts, checklists, and iterative feedback can improve goal-concordant end-of-life (EOL) care, reduce suffering and family trauma, support clinicians, and strengthen ECMO program learning systems. Full article
13 pages, 483 KB  
Article
Investigating the Average Glandular Dose and Exposure Parameters in Mammography Based on Compressed Breast Thickness and Imaging Projection: A Single-Centre Study in Jeddah, Saudi Arabia
by Dalal Alamoudi, Amna Babgi, Lama Bazuhayr, Shaza Alsharif, Amani Y. Alhalwani and Doaa Alamoudi
Healthcare 2026, 14(9), 1248; https://doi.org/10.3390/healthcare14091248 - 6 May 2026
Viewed by 360
Abstract
Introduction: The mammary gland is highly sensitive to ionising radiation, making the average glandular dose (AGD) the most appropriate metric for breast dosimetry. With increasing participation in breast screening programmes, cumulative radiation exposure remains a concern. This study aimed to investigate the correlation [...] Read more.
Introduction: The mammary gland is highly sensitive to ionising radiation, making the average glandular dose (AGD) the most appropriate metric for breast dosimetry. With increasing participation in breast screening programmes, cumulative radiation exposure remains a concern. This study aimed to investigate the correlation between AGD and exposure parameters under controlled conditions of compressed breast thicknesses and mammographic projections. Methods: A retrospective, cross-sectional analysis evaluated data from 609 patients who underwent clinically justified digital mammography examinations with a single direct digital radiography system at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between September 2023 and September 2025. The Shapiro–Wilk normality test indicated that AGD data were not normally distributed. Consequently, the Wilcoxon signed-rank test was used to assess differences between craniocaudal (CC) and mediolateral oblique (MLO) projections for the right and left breasts across CBT ranges. Spearman’s rank correlation coefficient was used to evaluate associations between AGD and exposure parameters (compression force (CF), mAs, and kVp) under controlled conditions of CBT ranges and projections. Results: AGD increased with CBT, rising from 1.36–1.39 mGy at 30–39 mm to 2.25–3.05 mGy at 70–79 mm. MLO projections consistently showed higher AGD than CC projections, with greater differences from 50–59 mm. Statistically significant differences were observed in projections across CBT. Spearman’s analysis demonstrated a significant positive correlation between AGD and CBT (p < 0.0001), which was strongest in the right MLO (ρ = 0.5082). Within the 50–59 mm range, AGD strongly correlated with mAs and moderately with kVp, but not with CF. Conclusions: AGD increases significantly with CBT, particularly in MLO projections. Within the 50–59 mm CBT range, mAs showed the strongest influence on AGD, while kVp had a moderate effect and CF was non-significant. These findings support dose optimisation through exposure parameter control and alignment with DRLs while maintaining image quality. Full article
(This article belongs to the Section Women’s and Children’s Health)
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18 pages, 307 KB  
Article
Exploring Students’ Perceptions and Usage of Artificial Intelligence in Supporting Mental Health: A Preliminary Study in Higher Education in Qatar
by Amani Safwat ElBarazi, Hatem Mohamed and Ramzi Nasser
Healthcare 2026, 14(9), 1247; https://doi.org/10.3390/healthcare14091247 - 6 May 2026
Cited by 1 | Viewed by 549
Abstract
Background: Artificial intelligence (AI) is widely used in mental health care for screening, monitoring, and intervention. Notably, most studies of AI in mental health have been performed in Western contexts, with limited evidence from the Arab Gulf region, where cultural factors such as [...] Read more.
Background: Artificial intelligence (AI) is widely used in mental health care for screening, monitoring, and intervention. Notably, most studies of AI in mental health have been performed in Western contexts, with limited evidence from the Arab Gulf region, where cultural factors such as stigma, privacy, and help-seeking norms may influence acceptance. Objective: Investigating university students’ perceptions of AI in mental health support, including awareness, trust, readiness, and preferences in a Gulf context. Methods: A cross-sectional survey was administered to 220 university students in Qatar. Data were analyzed using descriptive statistics, Chi-square tests, and one-way ANOVA to explore associations and group differences. Results: Students showed low-to-moderate levels of awareness and trust in AI-based mental health tools. The majority of participants showed that they were prepared to employ AI for stress management, but they do not prefer to replace face-to-face therapy, suggesting a preference for complementary use. A significant association was found between readiness and expectations (p < 0.00001), which means ambivalence toward AI effectiveness. No significant differences were observed across gender or academic level (p > 0.05). Key concerns included loss of human interaction, overreliance on technology, and diagnostic accuracy, while perceived benefits included cost reduction and 24/7 accessibility. Conclusions: Students exhibit cautious adoption of AI in mental health services. Acceptance is influenced by trust, privacy issues, and apparent compassion. AI is optimally situated as a supplementary instrument within ethically regulated, culturally attuned hybrid care frameworks that maintain the fundamental importance of human connection. Full article
(This article belongs to the Section Digital Health Technologies)
20 pages, 1301 KB  
Article
Anxiety, Psychological Resilience, and Physical Activity Among University Students: Mediation and Latent Profile Analyses
by Hui Peng, Syed Ghufran Hadier, Yuze Zhang, Syed Danish Hamdani and Syed Muhammad Zeeshan Haider Hamdani
Healthcare 2026, 14(9), 1246; https://doi.org/10.3390/healthcare14091246 - 5 May 2026
Viewed by 473
Abstract
Objective: This study examined whether psychological resilience mediates the association between anxiety and PA among Pakistani university students and, as a secondary aim, explored heterogeneity in these relationships using person-centred approach. Methods: A cross-sectional survey was conducted among 770 university students (aged 18–26 [...] Read more.
Objective: This study examined whether psychological resilience mediates the association between anxiety and PA among Pakistani university students and, as a secondary aim, explored heterogeneity in these relationships using person-centred approach. Methods: A cross-sectional survey was conducted among 770 university students (aged 18–26 years) from six cities in Punjab, Pakistan, between May and December 2025. Participants completed validated measures of anxiety (GAD-7), psychological resilience (CD-RISC-10), and self-reported PA. Correlation, regression, mediation, and latent profile analyses were performed, controlling for gender and academic year. Results: Anxiety was significantly and negatively correlated with both resilience (r = −0.475, p < 0.001) and PA (r = −0.378, p < 0.001), while resilience was positively associated with PA (r = 0.419, p < 0.001). Physical activity was significantly predicted by anxiety (B = −0.383, p < 0.001) and resilience (B = 0.174, p < 0.001) in regression models, explaining 21.7% of the variance in PA. The mediation analysis revealed that resilience explained 39% of the total effect of anxiety on PA, indicating partial mediation. LPA revealed three distinct profiles: an Anxious–Inactive group (27.1%) characterised by high anxiety and low resilience; a Moderately Distressed–Moderately Active group (47.0%) with intermediate levels; and a Resilient–Active group (25.8%) with low anxiety and high resilience. Conclusions: Lower physical activity among Pakistani university students is partly explained by reduced psychological resilience in the context of anxiety. These findings highlight the importance of resilience as a protective resource and support integrated mental health and physical activity interventions in resource-limited university settings. Full article
(This article belongs to the Section Mental Health and Psychosocial Well-being)
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18 pages, 270 KB  
Article
Renal Risk Medication Quick Guide to Aid Pharmacist-Led Medication Review in Frail Hospitalized Geriatric Patients: A Multicenter Exploratory Study
by Joo Hanne Poulsen Revell, Anne Byriel Walls, Trine Rune Høgh Andersen, Faruk Coric, Ulla Hedegaard, Charlotte Olesen, Anita Buch Grann Press, Lene Vestergaard Ravn-Nielsen, Lisa Greve Routhe and Lene Juel Kjeldsen
Healthcare 2026, 14(9), 1245; https://doi.org/10.3390/healthcare14091245 - 5 May 2026
Viewed by 414
Abstract
Background/objectives: Chronic kidney disease (CKD) affects approximately 800 million individuals worldwide and poses a growing health challenge. To support safer prescribing practices, our research group developed a renal risk medication quick guide (RRMQG), which provides recommendations for the 50 most prevalent renal risk [...] Read more.
Background/objectives: Chronic kidney disease (CKD) affects approximately 800 million individuals worldwide and poses a growing health challenge. To support safer prescribing practices, our research group developed a renal risk medication quick guide (RRMQG), which provides recommendations for the 50 most prevalent renal risk medications (RRMs). This study explored the usefulness of implementing the RRMQG in Danish hospital settings. Methods: In this multicenter pilot study conducted across six Danish hospitals, 28 clinical pharmacists applied the RRMQG during medication reviews of frail, geriatric patients with renal impairment from May to October 2023. Useability was explored through structured surveys completed by the pharmacists. Results: Among 182 patients, 378 RRMs were detected, and 14% of these were associated with potential drug-related problems (DRPs). The RRMs were distributed across 35 of the 50 from the RRMQG, and patients received an average of two RRMs each. Most pharmacists found the RRMQG manageable for implementation in practice. Conclusions: The RRMQG was useful and manageable for implementation in practice in Danish hospitals, particularly due to its medication-specific recommendations. However, adjustments to the RRMQG may be beneficial by, for example, adding opioids or context-relevant medications to meet individual needs. Full article
(This article belongs to the Section Clinical Care)
14 pages, 350 KB  
Article
Awareness of Colorectal Cancer Risk Factors and Prevention-Related Beliefs Among Adults in Saudi Arabia: A Cross-Sectional Survey
by Arezki Azzi, Abdulrahman A. Aljaser, Ahmed H. Alassaf, Haifa H. Allahem, Naif A. Almansour and Sultan K. Alblaihi
Healthcare 2026, 14(9), 1244; https://doi.org/10.3390/healthcare14091244 - 5 May 2026
Viewed by 376
Abstract
Background/Objectives: Lifestyle factors (diet, physical activity, body weight) play a key role in colorectal cancer (CRC) prevention. This study assessed awareness, beliefs, and self-reported practices related to diet and physical activity for CRC prevention among adults living in Saudi Arabia, and examined [...] Read more.
Background/Objectives: Lifestyle factors (diet, physical activity, body weight) play a key role in colorectal cancer (CRC) prevention. This study assessed awareness, beliefs, and self-reported practices related to diet and physical activity for CRC prevention among adults living in Saudi Arabia, and examined demographic correlates. Methods: An analytic cross-sectional online survey was conducted among 544 adults (≥18 years). Measures included sociodemographics, self-reported height/weight (BMI), dietary and lifestyle practices, and beliefs about the role of a healthy diet and physical activity in cancer prevention. Associations were assessed using χ2 tests with effect size (Cramér’s V) and crude odds ratios (ORs) with 95% confidence intervals (CI); p-values < 0.001 are reported as <0.001. Results: Most participants reported consuming <3 daily servings of fruit (80.1%) and vegetables (69.9%). Overall, 41.9% of participants reported that their current fruit/vegetable intake did not meet minimum recommendations for cancer prevention, and 36.8% reported the same for physical activity. Overall, 80.1% believed that a healthy diet can help prevent cancer, and 79.4% believed that regular physical activity can help prevent cancer. Compared with females, males had higher odds of endorsing diet (OR 1.86, 95% CI 1.16–2.98) and physical activity (OR 1.98, 95% CI 1.24–3.17) as cancer-preventive. Participants with a monthly income of ≥5000 SAR had higher odds of endorsing diet (OR 2.71, 95% CI 1.75–4.19) and physical activity (OR 1.68, 95% CI 1.10–2.55) compared with those earning < 5000 SAR. Conclusions: Despite high belief in the preventive role of diet and physical activity, many participants reported suboptimal fruit/vegetable intake and insufficient activity. While these cross-sectional findings preclude causal inference, they suggest that health-promotion efforts may benefit from prioritizing lower-income groups and women, with an emphasis on practical approaches to meeting CRC-prevention lifestyle recommendations. Full article
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15 pages, 1311 KB  
Article
Visceral Adiposity and Markers of Relative Sarcopenia in Young Adults with Normal Weight Obesity: Gender Differences
by Rodrigo Yáñez-Sepúlveda, Boryi A. Becerra-Patiño, Armando Monterrosa-Quintero, Carlos Abraham Herrera-Amante, César Octavio Ramos-García, Guillermo Cortés-Roco, Exal Garcia-Carrillo, Eduardo Guzmán-Muñoz, Yeny Concha-Cisternas and José Francisco López-Gil
Healthcare 2026, 14(9), 1243; https://doi.org/10.3390/healthcare14091243 - 5 May 2026
Viewed by 663
Abstract
Background and Objective: Body mass index (BMI) is a worldwide screening standard but fails to distinguish between fat mass and fat-free mass. This study examines the prevalence and metabolic profile of the normal weight obesity (NWO) phenotype in a large cohort of [...] Read more.
Background and Objective: Body mass index (BMI) is a worldwide screening standard but fails to distinguish between fat mass and fat-free mass. This study examines the prevalence and metabolic profile of the normal weight obesity (NWO) phenotype in a large cohort of young adults. Methods: A cross-sectional study of 4793 young adults (18–35 years) was conducted using bioelectrical impedance analysis (BIA). Participants were stratified into four phenotypes: underweight, healthy weight (HW), NWO, and obesity. Anthropometric indices, visceral fat area (VFA), and phase angle (PhA) were analyzed. Results: Within the normal BMI range (n = 2491), 40.6% (n = 1012) of patients were classified as NWO (percentage of body fat (PBF) >30% for women, >20% for men). NWO subjects showed a significantly higher VFA compared to the HW (+33.0 cm2 in men and +24.3 cm2 in women; p < 0.001) with a very large effect size (Cohen’s d > 2.0). Furthermore, a state of relative sarcopenia was identified, characterized by significantly lower skeletal muscle mass percentage (SMM%) and PhA (p < 0.001; d = −0.82), indicating compromised cellular integrity despite a normal BMI. Conclusions: BMI misclassifies 4 out of 10 young adults with excess adiposity. NWO is a high-risk phenotype linked to visceral adiposity and early cellular frailty. Incorporating BIA in routine screenings is essential to identify this invisible risk group. Full article
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13 pages, 551 KB  
Article
Temporal Changes in Affective Symptoms, Headache Burden, and Quality of Life Following rTMS Treatment in Migraine: A Longitudinal Study
by Robert Zgarbura, Alexandru Pavel, Oana-Andreea Parliteanu, Jari Sabri and Catalina Tudose
Healthcare 2026, 14(9), 1242; https://doi.org/10.3390/healthcare14091242 - 4 May 2026
Viewed by 376
Abstract
Background: Migraine is frequently associated with anxiety, depression, and reduced quality of life, contributing to substantial functional impairment. Objective: To examine longitudinal changes in affective symptoms, headache-related burden, and quality of life following repetitive transcranial magnetic stimulation (rTMS) in individuals with migraine. Methods: [...] Read more.
Background: Migraine is frequently associated with anxiety, depression, and reduced quality of life, contributing to substantial functional impairment. Objective: To examine longitudinal changes in affective symptoms, headache-related burden, and quality of life following repetitive transcranial magnetic stimulation (rTMS) in individuals with migraine. Methods: In this one-arm longitudinal study, 32 adults with migraine underwent 10 sessions of rTMS. Anxiety (HAMA), depression (HAMD), and migraine-specific quality of life were assessed at baseline, post-treatment, and 3-month follow-up, while headache impact (HIT-6) and disability (MIDAS) were evaluated at baseline and post-treatment. Repeated-measures analyses and paired comparisons were conducted. Results: Significant improvements over time were observed for anxiety, depression, and quality of life (all p < 0.001). Anxiety showed progressive improvement through follow-up, while depressive symptoms improved early with further consolidation at 3 months. Migraine-related quality of life increased significantly across all timepoints. Headache impact and disability decreased significantly following treatment (both p < 0.001), with large effect sizes. Conclusions: rTMS was associated with improvements in affective symptoms, migraine-related burden, and quality of life. However, given the one-arm design, these findings should be interpreted cautiously. Controlled studies are needed to confirm these results. Full article
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17 pages, 665 KB  
Article
Bridging the Knowledge–Practice Gap in Cervical Spine Injury First Aid: A Cross-Sectional Study in Southern Saudi Arabia
by Yahya H. Khormi, Mohammad A. Jareebi, Ali Y. Madkhali, Nasser A. N. Abu Alzawayid, Amjad H. Muthaffar, Taif A. Masri, Eyad M. Albarrati, Mohammed H. Hakami, Suha Ali Ageeli, Mohammed S. Alshahrani, Ruba M. Alzahrani, Faisal H. Tawashi, Ibrahim A. Hakami, Ghazi I. Al Jowf and Farjah H. Algahtani
Healthcare 2026, 14(9), 1241; https://doi.org/10.3390/healthcare14091241 - 4 May 2026
Viewed by 477
Abstract
Background/Objectives: Cervical spine injuries (CSIs) are life-threatening conditions commonly resulting from road traffic accidents and falls; improper first aid management can significantly worsen neurological outcomes. Public awareness and correct first aid response are critical for preventing secondary injury; despite this, available data from [...] Read more.
Background/Objectives: Cervical spine injuries (CSIs) are life-threatening conditions commonly resulting from road traffic accidents and falls; improper first aid management can significantly worsen neurological outcomes. Public awareness and correct first aid response are critical for preventing secondary injury; despite this, available data from the southern provinces of Saudi Arabia remain insufficient. This study aimed to assess public awareness and first aid preparedness for CSIs across four southern regions of Saudi Arabia. Methods: A cross-sectional design was employed across multiple regions, encompassing 1179 adults from Jazan, Aseer, Al-Baha, and Najran between 2025 and 2026. A validated online questionnaire was employed for data collection to assess CSI awareness, recognition of injury signs, and appropriate first aid responses. Awareness scores of ≥60% were classified as good. Multiple linear regression analysis was performed to identify independent predictors of awareness. Results: The mean awareness score was 16.0 ± 4.8 out of a possible total of 20 points, corresponding to 80% of the total score, with 87% of participants demonstrating good awareness. The majority of respondents recognized the importance of spinal immobilization (89%), maintaining head–neck alignment (95%), and contacting emergency services before intervention (93%). Correct responses to emergency scenarios were recorded in 83% of participants. Notably, only 39% had attended formal medical or trauma training, and merely 3% reported real-life first aid experience. Training attendance (β = 1.39, p < 0.001) and marital status (married; β = 1.37, p = 0.004) were identified as independent predictors of higher awareness scores. Conclusions: Although general public awareness of CSI first aid is high, formal training participation remains critically low, revealing a substantial gap between knowledge and practice. Integrating structured first aid training into community, workplace, and primary healthcare settings is essential to improve trauma outcomes and reduce preventable disability. Full article
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13 pages, 256 KB  
Review
Artificial Intelligence in Exams by Image: Ethical Pros and Cons
by Caio Zachini, Sofia Nunes, Francisca Rego and Rui Nunes
Healthcare 2026, 14(9), 1240; https://doi.org/10.3390/healthcare14091240 - 4 May 2026
Viewed by 427
Abstract
Background/Objectives: The world’s interest in the applications of artificial intelligence (AI) is rapidly increasing. In medicine, machine learning-based devices have proliferated, especially for image analysis, heralding significant new challenges for the use of AI in healthcare. Based on this context, this research [...] Read more.
Background/Objectives: The world’s interest in the applications of artificial intelligence (AI) is rapidly increasing. In medicine, machine learning-based devices have proliferated, especially for image analysis, heralding significant new challenges for the use of AI in healthcare. Based on this context, this research addresses the following question: What are the major bioethical issues related to the use of AI in radiological patient reports? Methods: This study examined the main bioethical concerns surrounding AI in radiological reports, based on a narrative literature review grounded in the works of prominent authors in the field of bioethics. Results: We highlight the legal frameworks regulating medical devices and data protection in the European Union and the United States of America, evaluating recent developments in the contemporary medical landscape. Conclusions: Despite progress, many issues remain unresolved and must be addressed in order to advance the regulation of AI applications in medicine. Full article
23 pages, 1058 KB  
Article
After-Hours Service Demands and Dentist Well-Being: Unpacking the Roles of Compassion Satisfaction and Organizational Support
by Fatma Mansour Abdulmawla, Sami Mohammad and Ayse Arslan
Healthcare 2026, 14(9), 1239; https://doi.org/10.3390/healthcare14091239 - 4 May 2026
Viewed by 375
Abstract
Background/Objective: This study examines how after-hours service demands (AHSD) are associated with dentists’ overall work experience (OWE) through the mediating role of compassion satisfaction (CS) and the moderating role of perceived organizational support (POS). Grounded in the Job Demands–Resources (JD-R) and Conservation of [...] Read more.
Background/Objective: This study examines how after-hours service demands (AHSD) are associated with dentists’ overall work experience (OWE) through the mediating role of compassion satisfaction (CS) and the moderating role of perceived organizational support (POS). Grounded in the Job Demands–Resources (JD-R) and Conservation of Resources (COR) theories, the study investigates how job demands, emotional resources, and organizational support jointly relate to dentists’ psychological well-being. Methods: Data were collected from 450 dentists across seven major Libyan cities—Tripoli, Benghazi, Misrata, Sabha, Al Bayda, Zawiya, and Derna—using a structured online questionnaire administered between May and August 2025. Results: Partial least squares structural equation modeling (PLS-SEM) results indicated that AHSD were positively associated with both CS and OWE, suggesting that demanding work conditions may, under certain conditions, coincide with more positive professional experiences when perceived as meaningful and supported. CS partially mediated the AHSD–OWE relationship, highlighting its role as a key emotional resource linked to more favorable work experiences. In addition, POS moderated the relationships between AHSD and CS, and between AHSD and OWE, although the effects were relatively modest, indicating that organizational support may provide incremental support in how dentists experience demanding work conditions rather than fundamentally altering these relationships. The moderated mediation analysis further suggested that the indirect association between AHSD and OWE via CS was stronger at higher levels of POS. Conclusions: Overall, the findings refine JD-R and COR perspectives by indicating that job demands, emotional resources, and organizational support are jointly associated with dentists’ work-related well-being in a high-demand healthcare context. Full article
(This article belongs to the Special Issue Well-Being of Healthcare Professionals: New Insights After COVID-19)
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23 pages, 807 KB  
Review
Organizational Climate Factors Influencing Job Satisfaction in Rural Health Care Workplaces in Upper-Middle-Income and High-Income Countries: A Scoping Review
by Ginger E. Minahan and Sandra C. Thompson
Healthcare 2026, 14(9), 1238; https://doi.org/10.3390/healthcare14091238 - 4 May 2026
Viewed by 312
Abstract
Background: Fostering job satisfaction in rural health workplaces is crucial due to its relationship with multiple outcomes such as physical and mental health, job performance, burnout, turnover intention, and retention. As knowledge of the organizational climate components which influence rural job satisfaction is [...] Read more.
Background: Fostering job satisfaction in rural health workplaces is crucial due to its relationship with multiple outcomes such as physical and mental health, job performance, burnout, turnover intention, and retention. As knowledge of the organizational climate components which influence rural job satisfaction is currently limited, this scoping review sought to identify organizational climate factors influencing job satisfaction among the rural health care workforce in upper-middle-income and high-income countries, organized by thematic categories for use in future workplace initiatives. Methods: Following JBI scoping review methodology and the PRISMA-ScR checklist, studies published between January 2013 and October 2023 were identified through searches of PubMed, APA PsycINFO, CINAHL, and Google Scholar. Eligible studies reported research evaluating organizational climate factors as facilitators of and/or barriers to job satisfaction among health care workers in rural regions of upper-middle-income and high-income countries. Screening was conducted in Covidence and data were extracted using a customized Excel tool. Results: Of 305 identified articles that underwent screening, eighteen studies were included in the final review. Thirteen components of organizational climate across studies were identified as facilitators of and/or barriers to job satisfaction in rural health care workplaces, and categorized into four overarching domains: interpersonal relationships, individual responsibilities, organizational structure and planning, and reward and professional development. Conclusions: Relationships with leadership, peer relationships, autonomy and freedom of working method, availability and quality of resources, workload and the ability to remain busy, and wages and benefits emerged as the most consistently identified components impacting job satisfaction across studies. Rural health care organizations are encouraged to prioritize these components and implement participatory, communicative leadership structures, foster team cohesion and support, develop health care worker autonomy and limit inefficient oversight structures, address resource gaps, coordinate with workers to determine manageable workloads, and implement competitive wages and benefits. Additional research is needed to better elucidate the associations between job satisfaction and organizational climate components as well as to longitudinally evaluate interventions aiming to foster rural health workers’ job satisfaction. Full article
(This article belongs to the Section Healthcare Organizations, Systems, and Providers)
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14 pages, 953 KB  
Article
Efficacy of Whole-Body Vibration on Scapular Muscle Activation Pattern and Latency Timing in Modified Push-Up Position in Overhead Athletes: A Randomized Control Trial
by Sana Saifi, Ishant Kumar Arora, Nitin Kumar Arora, Khushi Sharma and Saurabh Sharma
Healthcare 2026, 14(9), 1237; https://doi.org/10.3390/healthcare14091237 - 4 May 2026
Viewed by 436
Abstract
BACKGROUND: Overhead athletes are at increased risk of shoulder dysfunction due to repetitive, high-velocity movements that can disrupt scapular muscle activation patterns. Whole-body vibration (WBV) has been proposed as a training modality to enhance neuromuscular activation, but its effects on scapular muscle activity [...] Read more.
BACKGROUND: Overhead athletes are at increased risk of shoulder dysfunction due to repetitive, high-velocity movements that can disrupt scapular muscle activation patterns. Whole-body vibration (WBV) has been proposed as a training modality to enhance neuromuscular activation, but its effects on scapular muscle activity and activation timing remain unclear. METHODS: This randomized controlled trial investigated the effects of WBV-assisted push-up training on scapular muscle activation and onset latency in university-level overhead athletes. Forty participants were randomly assigned to a WBV group or a control group performing identical push-up exercises without vibration for four weeks. Surface electromyography was used to assess normalized muscle activation (%MVIC) and activation latency of the upper trapezius (UT), serratus anterior (SA), and lower trapezius (LT) before and after the intervention. A 2 × 2 mixed-model ANOVA was applied for statistical analysis. RESULTS: Significant time × group interactions were found for muscle activation in LT and SA (p < 0.01). The WBV group demonstrated substantially greater increases in activations in these muscles compared with the control group, with the largest improvements observed in the serratus anterior. No statistically significant between-group differences were identified for muscle onset latency (p > 0.05). CONCLUSIONS: Adding WBV to push-up training significantly enhances key scapular muscle activation in overhead athletes but does not significantly affect muscle onset latency. WBV-assisted push-ups may act as a practical, low-load strategy to improve scapular muscle recruitment and potentially reduce the risk of sports-related shoulder injuries and pain in overhead athletes. Full article
(This article belongs to the Special Issue Advances in Physical Therapy for Sports-Related Injuries and Pain)
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11 pages, 471 KB  
Article
Outcomes of Slow-Absorbable Biosynthetic Mesh (Phasix™) in Hernia Repair at Tertiary Care Center, Riyadh, Saudi Arabia
by Ibrahim Al Babtain, Sami Almalki, Wed Alwabel, Bader Alhoumaily, Ghala Albaqami, Shumukh Aldawsari and Khalid Alorf
Healthcare 2026, 14(9), 1236; https://doi.org/10.3390/healthcare14091236 - 4 May 2026
Viewed by 528
Abstract
Background/Objectives: Mesh repair reduces hernia recurrence compared with suture repair, but permanent synthetic meshes are associated with chronic foreign-body complications. Biosynthetic poly-4-hydroxybutyrate mesh (Phasix™) provides temporary reinforcement with gradual resorption; however, short-term real-world outcomes across different hernia types remain limited. This study evaluated [...] Read more.
Background/Objectives: Mesh repair reduces hernia recurrence compared with suture repair, but permanent synthetic meshes are associated with chronic foreign-body complications. Biosynthetic poly-4-hydroxybutyrate mesh (Phasix™) provides temporary reinforcement with gradual resorption; however, short-term real-world outcomes across different hernia types remain limited. This study evaluated short-term outcomes after Phasix™ hernia repair and identified factors associated with baseline recurrent hernia at presentation. Methods: This retrospective cohort included patients ≥ 16 years who underwent open or laparoscopic hernia repair with Phasix™ at King Abdulaziz Medical City (2020–2023). Patients receiving other mesh types were excluded. Demographic, operative, and postoperative data were analyzed. Multivariable logistic regression identified factors associated with baseline recurrent hernia. Results: Among the 228 patients (51.8% female; mean age 55 years), hernia types were incisional (36.0%), paraumbilical (26.3%), and inguinal (24.6%). Early complications were uncommon: seroma in 2.2% and surgical site infection in 1.8% at 1 month. One-year recurrence occurred in 1.3% (3/228). Female sex, prior incisional hernia repair, previous mesh removal, and open repair independently predicted baseline recurrent hernia, while laparoscopic repair was protective. Conclusions: Phasix™ repair demonstrated low short-term complication rates and rare 1-year recurrence across ventral and inguinal hernias. Short-term outcomes were driven mainly by patient and procedural factors rather than mesh-specific effects. Full article
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22 pages, 807 KB  
Systematic Review
Adoption of the Nutrition Care Process in Manual and Software Formats: A Systematic Review Across International Dietetic Settings
by Elina Polydorou, Stella A. Nicolaou, Dimitrios Papandreou, Antonis Zampelas and Eleni P. Andreou
Healthcare 2026, 14(9), 1235; https://doi.org/10.3390/healthcare14091235 - 3 May 2026
Viewed by 459
Abstract
Background/Objectives: The Nutrition Care Process (NCP) is a standardized model designed to improve the quality and consistency of nutrition care. However, its implementation remains variable across settings, influenced by factors such as time constraints, training, peer support, and technological infrastructure. This systematic review [...] Read more.
Background/Objectives: The Nutrition Care Process (NCP) is a standardized model designed to improve the quality and consistency of nutrition care. However, its implementation remains variable across settings, influenced by factors such as time constraints, training, peer support, and technological infrastructure. This systematic review aims to synthesize the available evidence on barriers and facilitators influencing the implementation of the NCP/NCPT and to explore how different documentation formats may influence its adoption. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines and included peer-reviewed studies published between 2009 and 2024 in English or Greek. Searches were conducted in MEDLINE, EMBASE, Scopus, CINAHL, and the Cochrane Library. Study quality was assessed using the National Heart, Lung, and Blood Institute (NIH) tool. A total of 11 reports representing eight studies were included, comprising cross-sectional, cohort, qualitative, and pilot designs. Results: The most commonly reported barriers to NCP implementation were lack of training, time constraints, and limited technological infrastructure. Key facilitators included support from national dietetic associations, peer collaboration, and access to electronic health records (EHRs). Electronic formats were more frequently described as supporting improved documentation practices, practitioner confidence, and workflow efficiency, whereas manual approaches were commonly reported as time-consuming and less structured. Conclusions: Digital integration of the NCP may support more consistent documentation practices and improved workflow processes; however, the current evidence is largely observational and heterogeneous. Evidence regarding patient-level outcomes remains limited, and definitive conclusions regarding the comparative effectiveness of implementation formats cannot be drawn. Further high-quality research is needed to evaluate the long-term clinical impact of NCP implementation. Full article
(This article belongs to the Special Issue Nutrition in Patient Care: Second Edition)
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14 pages, 389 KB  
Article
Can the Use of Telehealth Guidance Services Reduce Depressive Symptoms Among Family Caregivers of Older Adults with Cognitive Impairment? A Moderated-Mediation Model
by Li Li, Hao Zhou, Xiaorong Gao, Keke Chen and Qiaoqiao Wang
Healthcare 2026, 14(9), 1234; https://doi.org/10.3390/healthcare14091234 - 3 May 2026
Viewed by 317
Abstract
Background: Family caregivers of older adults with cognitive impairment commonly encounter heavy care burdens and elevated mental health risks, particularly depressive symptoms. This study aimed to explore the association between telehealth guidance service use and depressive symptoms among family caregivers of older adults [...] Read more.
Background: Family caregivers of older adults with cognitive impairment commonly encounter heavy care burdens and elevated mental health risks, particularly depressive symptoms. This study aimed to explore the association between telehealth guidance service use and depressive symptoms among family caregivers of older adults with cognitive impairment, and to further examine the mediating role of caregiving competence and the moderating role of psychological resilience. Methods: A cross-sectional survey of 491 family caregivers of older adults with cognitive impairment was conducted from August to October 2023. Descriptive statistics, correlation analysis, linear regression analysis, and moderated-mediating-effect analysis were employed. Results: Among the participants, only 17.31% reported using telehealth guidance services. Mean scores for caregiving competence, psychological resilience, and depressive symptoms were 3.04 ± 0.48, 27.11 ± 7.54, and 9.69 ± 1.46, respectively. Telehealth service use was positively associated with caregiving competence, and both telehealth service use and caregiving competence were negatively associated with depressive symptoms. The interaction between psychological resilience and caregiving competence was also significantly negatively associated with depressive symptoms (p < 0.01). Conclusions: Telehealth guidance service use is directly and indirectly negatively associated with depressive symptoms via caregiving competence. Psychological resilience moderates the relationship between caregiving competence and depressive symptoms. These findings contribute to a better understanding of factors linked to mental health among family caregivers of older adults with cognitive impairment. Full article
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17 pages, 796 KB  
Article
Development and Diagnostic Accuracy of a Novel Screening Tool for Early Detection of Pediatric Visual Impairment in Indonesian School-Aged Children
by Arya Ananda Indrajaya Lukmana, Tri Rahayu, Kianti Raisa Darusman, Ray Wagiu Basrowi and Nila Djuwita F. Moeloek
Healthcare 2026, 14(9), 1233; https://doi.org/10.3390/healthcare14091233 - 3 May 2026
Viewed by 383
Abstract
Background/Objectives: Uncorrected refractive errors (UREs) are a primary cause of preventable visual impairment in children globally, impacting education and quality of life. In Jakarta, prevalence has surged to 40% post-pandemic, categorizing it as a serious public health problem. This study aimed to develop [...] Read more.
Background/Objectives: Uncorrected refractive errors (UREs) are a primary cause of preventable visual impairment in children globally, impacting education and quality of life. In Jakarta, prevalence has surged to 40% post-pandemic, categorizing it as a serious public health problem. This study aimed to develop and validate the CIPSEL questionnaire as a rapid, culturally adapted screening tool for identifying visual impairment consistent with possible UREs among Indonesian school-aged children. Methods: A cross-sectional study was conducted in South Jakarta with 131 students aged 8–12 years. The 10-item CIPSEL questionnaire, exploring visual behaviors and symptoms, was administered via face-to-face interviews. Visual acuity was assessed using a standard Snellen chart by medical personnel blinded to the questionnaire results. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis, with optimal thresholds determined via the Youden Index and the shortest distance to (0, 1). Results: Visual impairment was identified in 26 students (19.8%). Mean CIPSEL scores were significantly higher in students with visual impairment (4.73) compared to those with normal vision (1.95). ROC analysis showed considerable diagnostic accuracy with an AUC of 0.887 (95% CI: 0.829–0.946). A safety-first cutoff of 2.5 prioritized sensitivity (96.2%), while a balanced cutoff of 3.5 provided 80.8% sensitivity and 79.0% specificity. A tiered risk system (Low, Medium, and High) demonstrated a robust statistical association with actual clinical findings (Cramer’s V = 0.534, p < 0.001). Conclusions: CIPSEL is a reliable and scalable screening tool for the early detection of visual impairment in Indonesian children. Its tiered risk stratification framework facilitates nuanced clinical decision-making and efficient resource allocation in school-based settings. Its accessibility for non-medical personnel and potential for digital integration support national efforts toward universal eye health. Full article
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10 pages, 688 KB  
Article
Evaluating the Efficacy and Safety of the LASIK Nonlinear Aspheric Micro-Monovision Surgery (Laser Blended Vision Surgery) in Correcting Presbyopia Among the Saudi Population
by Mohammed M. Althomali, Mohamed G. Eissa, Faisal N. Almushaweh, Ahmed A. Alharbi, Muteb K. Alanazi and Waleed S. AlTuwairqi
Healthcare 2026, 14(9), 1232; https://doi.org/10.3390/healthcare14091232 - 3 May 2026
Viewed by 444
Abstract
Background/Objectives: To evaluate the monocular and binocular visual outcomes for patients who underwent PRESBYOND Laser Blended Vision (LBV) surgery. Methods: A total of 46 patients participated in this study (mean age 47.5 yrs ± 4.7) with various refractive errors. Patients were treated using [...] Read more.
Background/Objectives: To evaluate the monocular and binocular visual outcomes for patients who underwent PRESBYOND Laser Blended Vision (LBV) surgery. Methods: A total of 46 patients participated in this study (mean age 47.5 yrs ± 4.7) with various refractive errors. Patients were treated using the MEL 90 excimer laser to correct their refractive errors. The patients were asked to attend follow-up sessions at intervals of 1, 3, and 6 months. A self-developed binary (Yes/No) satisfaction survey was then conducted at the end of the 6-month visit. Results: The mean preoperative spherical equivalent for the distance eyes was −0.42 ± 1.53, and for the near eyes was −0.4 ± 1.76. The mean logMAR for the uncorrected distance visual acuity after treatment and follow-up at one month, three months, and six months was 0.016, 0.037, and 0.028 (20/20 to 20/22 range), respectively. After treatment, 81% of patients achieved 20/22.5 vision or better, and 94% achieved 20/25 vision or better. For near vision, 100% of patients reached J2 print. After treatment, 97% of patients achieved 20/25 or better at distance and J2 or better at near. Patient satisfaction was 92%, with only 8% of patients reporting dissatisfaction. Conclusions: This protocol has demonstrated stable, well-tolerated, effective, and acceptable results in patients with presbyopia. The safety and efficacy of the procedure were demonstrated, with strong outcomes. Full article
(This article belongs to the Section Clinical Care)
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16 pages, 291 KB  
Article
Hybrid Cardiac Rehabilitation as an Optimal Strategy for Post-MI Recovery: A 14-Week Prospective Study on Clinical and Functional Outcomes
by Liviu Ionuț Șerbănoiu, Stefan Sebastian Busnatu, Dragos Trache, Gabriel Olteanu, Elena Serbanoiu, Abdul Basit, Narcisa Busnatu, Mihaela Mandu, Gelu Onose, Francesco Perone, Florin Mitu, Cătălina Liliana Andrei and Crina Julieta Sinescu
Healthcare 2026, 14(9), 1231; https://doi.org/10.3390/healthcare14091231 - 3 May 2026
Viewed by 431
Abstract
Background: Hybrid cardiac rehabilitation (CR) combining supervised and home-based phases with wearable monitoring may improve access and outcomes after myocardial infarction (MI). Objective: To assess the impact of a 14-week hybrid CR program on functional class, exercise capacity, hemodynamics, body composition, and [...] Read more.
Background: Hybrid cardiac rehabilitation (CR) combining supervised and home-based phases with wearable monitoring may improve access and outcomes after myocardial infarction (MI). Objective: To assess the impact of a 14-week hybrid CR program on functional class, exercise capacity, hemodynamics, body composition, and physical activity in post-MI patients with NYHA class II symptoms. Methods: Sixty-six adults post-MI underwent 2 weeks of in-hospital initiation followed by 12 weeks of home-based rehabilitation via a smartwatch–smartphone platform. Within-subject changes from baseline to week 14 were analyzed using appropriate paired statistical tests. Results: NYHA class improved significantly, with 39% of participants downgrading their class (p < 0.001). Body weight decreased by 1.27 ± 2.51 kg (p < 0.001). Systolic and diastolic blood pressures declined (both p ≤ 0.002). Maximal METS rose markedly (25.7% increase; p < 0.001), and watts/kg improved (p < 0.001). Resting heart rate decreased (p = 0.002); peak exercise heart rate change was non-significant. Fat mass declined and skeletal muscle mass increased (mean gain 0.98 kg; p < 0.001). Daily step count increased from 5550 ± 2026 to 7267 ± 2500 steps (p < 0.001). Total body water also increased (p < 0.001). Conclusions: The hybrid CR program produced significant improvements in functional class, exercise capacity, blood pressure, body composition, and physical activity in post-MI NYHA II patients, supporting its effectiveness as a remotely enabled secondary prevention strategy. However, the results are based on hypotheses and randomized controlled trials must confirm the benefits especially with a control group. Nonetheless, it is a feasible and potentially effective alternative to conventional programs in resource-limited settings. Full article
18 pages, 771 KB  
Article
Experiences of Loss and Grief Among Brazilian Frontline Healthcare Professionals During the COVID-19 Pandemic Crisis: A Grounded Theory Analysis
by Paola Kallyanna Guarneri Carvalho de Lima, Carlos Laranjeira, Amira Mohammed Ali, Feten Fekih-Romdhane, Murat Yıldırım, Lígia Carreira and Maria Aparecida Salci
Healthcare 2026, 14(9), 1230; https://doi.org/10.3390/healthcare14091230 - 3 May 2026
Viewed by 454
Abstract
Background/Objectives: The COVID-19 pandemic exerted unprecedented pressure on healthcare professionals and systems worldwide. To manage this increased demand, hospitals extended working hours, resulting in increased strain on workers and impacting their professional well-being. Simultaneously, the numerous deaths due to illness meant that [...] Read more.
Background/Objectives: The COVID-19 pandemic exerted unprecedented pressure on healthcare professionals and systems worldwide. To manage this increased demand, hospitals extended working hours, resulting in increased strain on workers and impacting their professional well-being. Simultaneously, the numerous deaths due to illness meant that healthcare professionals did not have sufficient time to process grief, which may have led to unresolved grief and other mental health problems. The aim of this study was to understand the experiences of loss and grief and their repercussions on Brazilian healthcare professionals working on the front lines during the COVID-19 pandemic. Methods: This qualitative study followed Charmaz’s constructivist grounded theory. The study used the COREQ checklist. Between August 2024 and January 2025, 24 healthcare professionals who worked on the front lines during the COVID-19 pandemic were interviewed via telephone. Participants were primarily female (n = 14) with a mean age of 42 years (SD = 9.13). Interviews were audio-recorded and transcribed. Results: The core phenomenon that emerged from the analytical process is “between exhaustion and resilience in a war-like scenario: challenges and opportunities in the care provided by frontline professionals during the COVID-19 pandemic”. This main axis was anchored in three categories: (1) adversities imposed by COVID-19 on the functioning of health services; (2) witnessing sudden deaths and the physical absence of families; (3) reconstruction of meanings and personal and professional growth. Conclusions: The experience of grief was intensified by the peculiarities permeating the death process in the pandemic context and the modification of farewell moments. The study exposes a need for training programs focused on medical, nursing, psychological, and other areas of care education that involve not only understanding clinical issues but also recognizing loss and grief as an integral part of care processes. Importantly, legislators should allocate additional resources to services that provide psychological support to healthcare professionals, in order to promote their adaptive coping. Full article
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15 pages, 735 KB  
Article
From Misperception to Prevention: Improving Cardiovascular Health and Risk Perception Through Risk Communication in Hungary
by Blanka Ehrenberger, Orsolya Papp-Zipernovszky, Alexandra Assabiny, József Otohal, Gergely Koplányi, Béla Merkely, Zsolt Bagyura, Márta Csabai and Zsófia Ocsovszky
Healthcare 2026, 14(9), 1229; https://doi.org/10.3390/healthcare14091229 - 3 May 2026
Viewed by 279
Abstract
Background/Objectives: Effective cardiovascular prevention requires improved risk perception and appropriate communication strategies that support cost-effective interventions. This study evaluated one-year changes in cardiovascular risk estimation accuracy and examined associations between communication strategies, accuracy, and health outcomes. Methods: We analyzed 200 participants (mean age: [...] Read more.
Background/Objectives: Effective cardiovascular prevention requires improved risk perception and appropriate communication strategies that support cost-effective interventions. This study evaluated one-year changes in cardiovascular risk estimation accuracy and examined associations between communication strategies, accuracy, and health outcomes. Methods: We analyzed 200 participants (mean age: 56.06 ± 6.26; 32.2% male) in a population-based study conducted in Hungary. Cardiovascular risk was calculated using the Framingham Risk Score based on laboratory and anthropometric measures, and subjective risk perception was assessed and categorized as realistic, optimistic, or pessimistic relative to objective risk. All participants received written risk feedback, while subgroups additionally participated in individual or group-based risk communication. Results: After 12 months, the proportion of participants with accurate risk perception increased from 39.0% to 50.5% (p = 0.012), accompanied by a significant reduction in pessimistic estimations (p = 0.013). We could not observe significant differences in estimation accuracy between communication strategies. The written-only communication group showed a significant decrease in cardiovascular risk factors (weight (p = 0.014), BMI (p = 0.042), blood pressure (p = 0.035), and LDL levels (p = 0.001)). No significant differences were found in health outcomes between risk communication groups. Conclusions: These results demonstrate that even written-only communication may be an effective way to improve cardiovascular health outcomes, possibly by correcting risk perception gaps, suggesting that cost-effective, low-intensity communication strategies may be sufficient to support primary prevention efforts. Full article
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11 pages, 228 KB  
Article
Determinants of Quality of Life in Saudi Adults with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Jeddah
by Amani A. Alrasheedi and Buthaina M. Aljehany
Healthcare 2026, 14(9), 1228; https://doi.org/10.3390/healthcare14091228 - 3 May 2026
Viewed by 355
Abstract
Objective: This study aimed to assess quality of life (QoL) and its determinants among Saudi adults diagnosed with type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study was conducted among 200 (45% male and 55% female) Saudi adults with T2DM aged 30–65 years. [...] Read more.
Objective: This study aimed to assess quality of life (QoL) and its determinants among Saudi adults diagnosed with type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study was conducted among 200 (45% male and 55% female) Saudi adults with T2DM aged 30–65 years. Data were collected using the Audit of Diabetes–Dependent Quality of Life (ADDQoL) and the Personal Diabetes Questionnaire (PDQ). Anthropometric and clinical measures included weight, height, body mass index (BMI), blood pressure, and glycated hemoglobin (HbA1c). Results: Most participants (73.5%) were ≤50 years of age, and the majority were obese (56.0%) or overweight (28.0%). Nearly half (54.5%) had HbA1c levels ≥ 8.0%, while (50.5%) were hypertensive. Overall, 96% of participants reported a poor to extremely poor QoL. Female sex (p = 0.003), higher BMI (p = 0.034), diet type (p = 0.039), and satisfaction with glucose control (p < 0.001) were significantly associated with the QoL. Conclusions: T2DM substantially impairs the QoL of affected Saudi adults. Psychosocial and lifestyle-related factors, particularly obesity, gender, dietary practices, and perceived glucose control, are more influential than traditional clinical markers. Culturally tailored interventions targeting these determinants may improve patient outcomes. Full article
(This article belongs to the Special Issue Health Promotion and Quality of Life in People with Diabetes)
17 pages, 611 KB  
Article
Sciatica and Mental Well-Being Among Saudi Women: A Cross-Sectional Investigation
by Mohammad A. Jareebi
Healthcare 2026, 14(9), 1227; https://doi.org/10.3390/healthcare14091227 - 2 May 2026
Viewed by 461
Abstract
Background/Objectives: Sciatica can adversely affect mental well-being; however, evidence regarding its psychological impact among Saudi women remains scarce, particularly concerning differential effects across specific mental health domains. This study examined the prevalence of sciatica and its associations with depression, anxiety, and stress among [...] Read more.
Background/Objectives: Sciatica can adversely affect mental well-being; however, evidence regarding its psychological impact among Saudi women remains scarce, particularly concerning differential effects across specific mental health domains. This study examined the prevalence of sciatica and its associations with depression, anxiety, and stress among adult Saudi women. Methods: A cross-sectional online survey was conducted from February to March 2024 among Saudi women aged ≥18 years. Participants (n = 706) completed the Arabic Depression, Anxiety, and Stress Scale (DASS-21) and provided sociodemographic and health information. Sciatica status was based on self-report. Multivariable linear regression analyses identified independent predictors of each mental health domain. Results: Sciatica prevalence was 11.0% among 706 participants (mean age 29 ± 11 years; mean BMI 24 ± 6.5 kg/m2). Sciatica was the strongest independent predictor of stress (β = 6.87, 95% CI: 4.57–9.17, p < 0.001). No significant associations were observed with depression (β = 1.80, p = 0.183) or anxiety (β = 0.45, p = 0.481). Additional stress predictors included lower-back pain, diabetes, lower–middle income, and daily phone use >8 h, while bachelor-level education was protective. Arthritis independently predicted anxiety (β = 1.52, p = 0.008). Conclusions: In this convenience sample of Saudi women, sciatica was significantly associated with higher stress symptom scores, while associations with depression and anxiety did not reach statistical significance. The observed pattern suggests that stress screening and management should be considered within biopsychosocial care for sciatica patients, pending confirmation in prospective studies. Full article
(This article belongs to the Section Women’s and Children’s Health)
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